Clinical Outcomes of Deferred Lesions by IVUS Versus FFR-Guided Treatment Decision

doi:10.1161/CIRCINTERVENTIONS.123.013308

. 2023 Dec;16(12):e013308.

doi: 10.1161/CIRCINTERVENTIONS.123.013308. Epub 2023 Nov 29.

Clinical Outcomes of Deferred Lesions by IVUS Versus FFR-Guided Treatment Decision

Joo Myung Lee^#¹, Hangyul Kim^#¹, David Hong^#¹, Doyeon Hwang², Jinlong Zhang³, Xinyang Hu³, Jun Jiang³, Chang-Wook Nam⁴, Joon-Hyung Doh⁵, Bong-Ki Lee⁶, Weon Kim⁷, Jinyu Huang⁸, Fan Jiang⁹, Hao Zhou¹⁰, Peng Chen¹¹, Lijiang Tang¹², Wenbing Jiang¹³, Xiaomin Chen¹⁴, Wenming He¹⁵, Jeehoon Kang², Sung-Gyun Ahn¹⁶, Myeong-Ho Yoon¹⁷, Ung Kim¹⁸, You-Jeong Ki¹⁹, Eun-Seok Shin²⁰, Ki Hong Choi¹, Taek Kyu Park¹, Jeong Hoon Yang¹, Young Bin Song¹, Seung-Hyuk Choi¹, Hyeon-Cheol Gwon¹, Bon-Kwon Koo², Hyo-Soo Kim², Seung-Jea Tahk¹⁷, Jian'an Wang^{2

3}, Joo-Yong Hahn¹; FLAVOUR Investigators

Affiliations

¹ Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L., H.K., D. Hong, K.H.C., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.).
² Seoul National University Hospital, Republic of Korea (D. Hwang, J.K., B.-K.K., H.-S.K., J.W.).
³ The Second Affiliated Hospital (J.Z., X.H., J.J., J.W.), Zhejiang University School of Medicine, China.
⁴ Keimyung University Dongsan Medical Center, Daegu, Republic of Korea (C.-W.N.).
⁵ Inje University Ilsan Paik Hospital, Goyang, Republic of Korea (J.-H.D.).
⁶ Kangwon National University Hospital, Chuncheon, Republic of Korea (B.-K.L.).
⁷ Kyung Hee University Hospital, Seoul, Republic of Korea (W.K.).
⁸ Affiliated Hangzhou First People's Hospital (J.H.), Zhejiang University School of Medicine, China.
⁹ Hangzhou Normal University Affiliated Hospital, China (F.J.).
¹⁰ The First Affiliated Hospital of Wenzhou Medical University, China (H.Z.).
¹¹ The Second Affiliated Hospital of Wenzhou Medical University, China (P.C.).
¹² Zhejiang Hospital, Hangzhou, China (L.T.).
¹³ The Third Clinical Institute Affiliated to Wenzhou Medical University, China (W.J.).
¹⁴ Ningbo First Hospital, China; (X.C.).
¹⁵ The Affiliated Hospital of Medical School of Ningbo University, China (W.H.).
¹⁶ Wonju Severance Christian Hospital, Republic of Korea (S.-G.A.).
¹⁷ Ajou University Hospital, Suwon, Republic of Korea (M.-H.Y., S.-J.T.).
¹⁸ Yeungnam University Medical Center, Daegu, Republic of Korea (U.K.).
¹⁹ Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Republic of Korea (Y.-J.K.).
²⁰ Ulsan University Hospital, University of Ulsan College of Medicine, Republic of Korea (E.-S.S.).

^# Contributed equally.

PMID: 38018840
DOI: 10.1161/CIRCINTERVENTIONS.123.013308

Clinical Outcomes of Deferred Lesions by IVUS Versus FFR-Guided Treatment Decision

Joo Myung Lee et al. Circ Cardiovasc Interv. 2023 Dec.

. 2023 Dec;16(12):e013308.

doi: 10.1161/CIRCINTERVENTIONS.123.013308. Epub 2023 Nov 29.

Authors

Affiliations

¹ Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L., H.K., D. Hong, K.H.C., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.).
² Seoul National University Hospital, Republic of Korea (D. Hwang, J.K., B.-K.K., H.-S.K., J.W.).
³ The Second Affiliated Hospital (J.Z., X.H., J.J., J.W.), Zhejiang University School of Medicine, China.
⁴ Keimyung University Dongsan Medical Center, Daegu, Republic of Korea (C.-W.N.).
⁵ Inje University Ilsan Paik Hospital, Goyang, Republic of Korea (J.-H.D.).
⁶ Kangwon National University Hospital, Chuncheon, Republic of Korea (B.-K.L.).
⁷ Kyung Hee University Hospital, Seoul, Republic of Korea (W.K.).
⁸ Affiliated Hangzhou First People's Hospital (J.H.), Zhejiang University School of Medicine, China.
⁹ Hangzhou Normal University Affiliated Hospital, China (F.J.).
¹⁰ The First Affiliated Hospital of Wenzhou Medical University, China (H.Z.).
¹¹ The Second Affiliated Hospital of Wenzhou Medical University, China (P.C.).
¹² Zhejiang Hospital, Hangzhou, China (L.T.).
¹³ The Third Clinical Institute Affiliated to Wenzhou Medical University, China (W.J.).
¹⁴ Ningbo First Hospital, China; (X.C.).
¹⁵ The Affiliated Hospital of Medical School of Ningbo University, China (W.H.).
¹⁶ Wonju Severance Christian Hospital, Republic of Korea (S.-G.A.).
¹⁷ Ajou University Hospital, Suwon, Republic of Korea (M.-H.Y., S.-J.T.).
¹⁸ Yeungnam University Medical Center, Daegu, Republic of Korea (U.K.).
¹⁹ Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Republic of Korea (Y.-J.K.).
²⁰ Ulsan University Hospital, University of Ulsan College of Medicine, Republic of Korea (E.-S.S.).

^# Contributed equally.

PMID: 38018840
DOI: 10.1161/CIRCINTERVENTIONS.123.013308

Abstract

Background: There are limited data regarding the safety of deferral of percutaneous coronary intervention based on intravascular ultrasound (IVUS) findings. The current study sought to compare the prognosis between deferred lesions based on IVUS and fractional flow reserve (FFR)-guided treatment decision.

Methods: This study is a post hoc analysis of the FLAVOUR randomized trial (Fractional Flow Reserve and Intravascular Ultrasound for Clinical Outcomes in Patients With Intermediate Stenosis) that compared 2-year clinical outcomes between IVUS- and FFR-guided treatment decision on intermediate coronary artery lesions using predefined criteria. In both IVUS and FFR groups, vessels were classified into deferred or revascularized vessels, and patients were classified as those with or without deferred lesions. Vessel-oriented composite outcomes (cardiac death, target vessel myocardial infarction, or target vessel revascularization) in deferred vessels and patient-oriented composite outcomes (death, myocardial infarction, or any revascularization) in patients with deferred lesions were compared between the IVUS and FFR groups.

Results: A total of 1682 patients and 1820 vessels were analyzed, of which 922 patients and 989 vessels were deferred. At 2 years, there was no difference in the cumulative incidence of vessel-oriented composite outcomes in deferred vessels between IVUS (n=375) and FFR (n=614) groups (3.8% versus 4.1%; hazard ratio, 0.91 [95% CI, 0.47-1.75]; P=0.77). The risk of vessel-oriented composite outcomes was comparable between deferred and revascularized vessels following treatment decision by IVUS (3.8% versus 3.5%; hazard ratio, 1.09 [95% CI, 0.54-2.19]; P=0.81) and FFR (4.1% versus 3.6%; hazard ratio, 1.14 [95% CI, 0.56-2.32]; P=0.72). In comparison of patient-oriented composite outcomes in patients with deferred lesions, there was no significant difference between the IVUS (n=357) and FFR (n=565) groups (6.2% versus 5.9%; hazard ratio, 1.05 [95% CI, 0.61-1.80]; P=0.86).

Conclusions: In patients with intermediate coronary artery stenosis, deferral of percutaneous coronary intervention based on IVUS-guided treatment decision showed comparable risk of clinical events with FFR-guided treatment decision.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02673424.

Keywords: coronary artery disease; coronary vessels; myocardial infarction; percutaneous coronary intervention; prognosis.

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Conflict of interest statement

Disclosures Dr Lee received an institutional research grant from Abbott Vascular, Boston Scientific, Philips Volcano, Terumo Corporation, Donga-ST, and Zoll Medical. Dr Hahn received an institutional research grant from the National Evidence-Based Healthcare Collaborating Agency, Ministry of Health and Welfare, Republic of Korea, Abbott Vascular, Biosensors, Boston Scientific, Daiichi Sankyo, Donga-ST, Hanmi Pharmaceutical, and Medtronic, Inc. The other authors report no conflicts.

Comment in

Deferring PCI Based on IVUS Assessment: On Par With FFR or FLAVOUR of the Week?
Maffey MW, Cavender MA, Bagur R. Maffey MW, et al. Circ Cardiovasc Interv. 2023 Dec;16(12):e013649. doi: 10.1161/CIRCINTERVENTIONS.123.013649. Epub 2023 Nov 29. Circ Cardiovasc Interv. 2023. PMID: 38018839 No abstract available.

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Clinical Outcomes of Deferred Lesions by IVUS Versus FFR-Guided Treatment Decision

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Clinical Outcomes of Deferred Lesions by IVUS Versus FFR-Guided Treatment Decision

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